Smart card licenses and enforced quotas proposed to combat smoking

If you quit smoking, you get your license fees back—plus interest.

A public health professor has published a paper proposing that smokers be forced to apply for licences and given weekly quotas.

In his paper, published in PLOS Medicine, Simon Chapman of the University of Sydney's School of Public Health says that by issuing every smoker with a paid-for smartcard to buy cigarettes, governments will be able to gather data the health authorities can then use in anti-smoking campaigns.

Every time they buy a pack of cigarettes the smart card will need to be swiped and, depending on what annual license level the individual has purchased, the numbers will be totted up and they will be cut off when they reach their maximum weekly limit (70 per week, 140 per week or 350 per week). The higher the limit, the more the licence will cost, deterring, says Chapman, lower-income individuals: "Poor smokers, as a group, are known to be more responsive to price than those on higher incomes, in terms of both quitting and reducing use." This may perturb the world's one billion smokers, 80 percent of which, according to the World Health Organisation, reside in low- and middle-income countries.

Chapman's argument is based on a pretty simplistic premise: if we need prescriptions to get hold of potentially harmful or addictive drugs, why don't cigarettes fall into this category?

"The prescription system is in effect a system of temporary licencing to use restricted substances," he writes in the paper. "Travellers carrying restricted drugs across borders can be required to show that they have a 'licence' to be in possession of some drugs… By contrast, tobacco products can be sold by any retailer… smokers can buy unlimited quantities of tobacco. Many nations outlaw sales to minors, but prosecutions are rare and sales to children common. In contrast to the highly regulated way we allow access to life-saving and health-enhancing pharmaceuticals, this is how we regulate access to a product that kills half its long-term users."

Based on the fact that smoking kills almost six million people each year, it should fall into the same category as things like firearms and fireworks, which are heavily restricted, argues Chapman. Sheer inconvenience and cost will not be the only deterrents of this system—Chapman calls the license fee "neither trivial nor astronomical... set at a sufficient level to give smokers some pause."

Most users will sign up online, and once their contact details have been obtained, anti-smoking messages of encouragement will be e-mailed to the user. There will also be financial incentives to stop smoking—if a user decides not to renew their license, they will be given back all the fees they paid to date, with interest. There should also be a critical cut-off point for this, so people give pause for thought about the financial burden of not giving up. New smokers, those turning 18, will have to take a "knowledge of risk test" before being granted a licence.

Chapman is not so naïve as to think there would not be a minor public outcry from smokers and sceptics alike, so although he touches on issues such as black market up-take, he has also asked Jeff Collin, political scientist and director of the Global Public Health Unit, to respond.

In Collin's "The Case against a Smoker's License," he argues that in some countries it would be a totally impractical system—for instance, in the UK, where "successive governments have failed to introduce identity cards."

"If it's very difficult to envisage health advocates securing support for a comparable scheme on the basis of a public health rationale, it is still harder to see why they should wish to."

His paper also suggests Chapman's strategy would make smokers feel like registered addicts, stigmatising the habit and creating demeaning scenarios for low income individuals: "The proposal to require licences will inevitably be widely perceived as demeaning, onerous, and punitive, and in explicitly targeting smokers would dramatically exacerbate the sense that smoking 'just has that sort of feel about it, a leper.'"

Collin does, however, agree that Chapman's argument of raising the legal smoking age by one year, every year, is worth consideration. He also concedes that there should be some restrictions on sales, considering some studies into hours of sale suggest putting restrictions in place could have a great effect.

"It is indeed an historical absurdity that so dangerous a product should be so readily available," he writes, but the rigidity of Champan's system is probably not the answer. Rather, Collin wants more creative and innovative techniques that look to undo the very nature of the mass manufacturing and promotion of tobacco we have all come to accept. Aside from the aforementioned tweaks to the system, Collin doesn't appear to have an alternative, however.

Completely changing the rules of the game halfway through has not proven effective in the past. For instance, in Bhutan the government attempted to enforce an outright ban on the sale of tobacco in 2005. However, by 2009 the authorities were already debating the bill after smuggling cigarettes became big business. It's also probably not good for the country's community relations when it threatens to jail a Buddhist monk for five years for being in possession of chewing tobacco.

152 Reader Comments

This is a pretty bad idea. Smoking is already so heavily taxed that there's a huge smuggling market. I've never been a smoker but even I know exactly where to buy cigarettes at half the price of retail.

Smoking is already stigmatized. Couple it with a complicated and easily game-able licensing system and I can't see how it affects anything.

If smoking is really that bad, just outlaw it. Put mild penalties and weak enforcement on users to prevent another "war on drugs" debacle, but get it out of stores, get rid of advertising and get rid of the industry.

Of course that will never happen, because smoking (much like the lotteries) is hugely lucrative to the government and a great way to get the poor to tax themselves. I'd say lobbyists would prevent it too, but frankly the smoking industry lobbyists seem pretty impotent these days.

If you want to quit smoking good for you. If you don't wanna quit smoking that's great too. The religious zeal with which so many attack the smoking issue is insane to me. There really isn't any credible data which shows a definite link between smoking and cancer. There's isn't even any that can show a define link between 2nd hand smoke and cancer. This is why the American Cancer Association will never say if you smoke you will get cancer. They always use the qualifier 'may' when speaking on this topic. I don't get why weed is illegal yet Alcohol and tobacco aren't. Fact is there are plenty of people who have been life long smokers who NEVER developed cancer. Also, there are plenty of lifelong non-smokers who develop lung cancer and other cancers traditionally attributed to smoking.

Education is all that should be done. I doubt there's a person (of reasonable age) alive in the United States that is unaware of smoking's harmful effects. But many still choose to smoke. Inform the public, but let them make their own choice.

Issues like this are why, despite its practical benefits, I balk at the idea of a single-payer healthcare system in the USA. Once the government has that power, they can start dictating lifestyle changes like this.

If you want to quit smoking good for you. If you don't wanna quit smoking that's great too. The religious zeal with which so many attack the smoking issue is insane to me. There really isn't any credible data which shows a definite link between smoking and cancer. There's isn't even any that can show a define link between 2nd hand smoke and cancer. This is why the American Cancer Association will never say if you smoke you will get cancer. They always use the qualifier 'may' when speaking on this topic. Fact is there are plenty of people who have been life long smokers who NEVER developed cancer. Also, there are plenty of lifelong non-smokers who develop lung cancer and other cancers traditionally attributed to smoking.

Number 1) The American Cancer Association will gladly tell you that the risk of cancer is greatly exacerbated when coupled with smoking.

Number 2) As the child of a parent who has severe asthma, I can say with certainty that her asthma was tripped every time she was around second hand smoke!

Number 3) Smoking most certainly causes emphysema, a disease that's both crippling and expensive to treat.

Number 4) Smoking is very clearly linked to numerous other diseases.

I'm not saying we need to ban smoking. But to say, like you implied, that smoking is harmless, is pure bullshit. Smoking is also a tax on public health, and as such, smokers should pay more for healthcare insurance. Smoking is a known risk, a risk that people should be able to take upon themselves in a free society, but a risk none the less. Excessive taxation is not the answer, black markets will always appear when legit markets fail.

It seems the proposal is primarily based on making smokers pay more. Where I live most all tobacco products are already heavily taxed. If there is need for a greater financial disincentive just raise the taxes more, the system is already in place and there is no need to add another layer of administration in the form of licenses. Having a license in place will not make it any easier of harder for children to get access. I could see insurance companies loving this though since they would have a very easy time identifying smokers and raising their premiums.

"The proposal to require licences will inevitably be widely perceived as demeaning, onerous, and punitive, and in explicitly targeting smokers would dramatically exacerbate the sense that smoking 'just has that sort of feel about it, a leper.'"

Isn't that kinda the point?

Also, yeah, the black market would quickly fill the gap. People already smuggle cigarettes to avoid taxes and this would be no different.

Finally, I've always be impressed with how generous smokers are with other smokers. If a smoker goes up to another, total stranger, and asks for a cigarette, 9 times out of 10 they will comply. I mean, you wouldn't go up to a total stranger and ask if they can spare a sandwich, but asking for a cigarette is somehow socially acceptable. I wonder if having a monthly quota on your "smart card" would break that feeling of comradeship between smokers.

I'm sure smokers the world across will thank "Mayor Bloomberg" Chapman for fighting on their behalf by shining a spotlight on them and driving up costs.

If people want to smoke, that's their choice. If it costs more to insure them, charge them for it. If you don't want to be around it, lots of places are banning smoking on premises with the exception of a "smoker's area."

I'm going to make a killing selling my quota on the black market. Seriously, this article doesn't even pretend to address the obvious holes in their scheme. It's a terrible article.

FTFA:

Quote:

Chapman is not so naïve as to think there would not be a minor public outcry from smokers and sceptics alike, so although he touches on issues such as black market up-take, he has also asked Jeff Collin, political scientist and director of the Global Public Health Unit, to respond.

If you are really interested, you can go read both articles. This is a summary, not a detailed blow-by-blow.

Where I work you have to pay an additional $16.50 a week in order to smoke at home and to carry medical insurance. You have no choice on the matter. If you smoke the money will be taken out of your check. They also do tell you that if you are seen out in public, and you are smoking, and that you have stated on our yearly health assessment that you do not smoke , you could be punished and even lose your job. Even your spouse, who may not even work where you do, still has to follow the same rules. The bad thing about this is that there is no way it can be enforced and at the same time there is no way you can fight it. I don't smoke anymore but I really don't think that it's proper to try to control a person's life in that manner.

There really isn't any credible data which shows a definite link between smoking and cancer

You're joking, right ? Or at least, just trolling ?

Let me help you here with something that isn't really academic, but will you give you several proper sources to researches that show that, when you get out of the tobacco-sponsored "researches", there is a wide consensus on the matter: http://bit.ly/T063iG

Quote:

This is why the American Cancer Association will never say if you smoke you will get cancer.

No, that isn't the reason. Of course, to understand the true reason, you will need to also understand a few basic facts about statistics so I suggest you do a bit of homework there as well.

Quote:

The religious zeal with which so many attack the smoking issue is insane to me.

I kept that for the end because, strangely, that's probably the remark you made that seems the most interesting to me.

For a start, you're right: there is a real will in many places to force people to quit smoking that sometimes borders the irrational.

However, I must also submit to you that there is a wide difference between one place and the other.

Let me explain. Smoking might be viewed as exercising your right to chose to do something that is potentially harmful if you chose to. I used to race cars and I can very well understand that situation. There is, however, a couple of differences:- Smoking has the bad tendency to impact people around you. Notwithstanding you apparent dismissal of academical studies when they do not go in a direction you like, that is a widelyacceptedfact. In such a situation, I'm sure you'd agree that you personal liberties should stop where (or close to where) the right of other peoples stops.- I'm not familiar enough with the healthcare structure of the US to speak about the specifics of that country, but in Europe (even here in very liberal Switzerland), costs incurred by diseases linked to smoking are costing the society a LOT of money. if there was an unlimited supply of money, that wouldn't bother me. But the fact is that money is, indeed, limited and our public health care systems are often stretched to the breaking point in many cases (that's a subject for another discussion). In that situation, I don't see why smokers shouldn't be taxed to the amount of money they cost and why they shouldn't be ostracized.

I could see insurance companies loving this though since they would have a very easy time identifying smokers and raising their premiums.

Is that a bad thing? If you choose to smoke, why should I subsidize your habit with my insurance premiums?

It just doesn't stop at smoking. We may have to subsidize your weight, your cholesterol, your blood sugar, your blood pressure, your triglycerides, and anything else they can find with our insurance premiums. This is a fact and is being done now. If you are going to start blaming people for your high insurance rate then you have to blame everyone because they are soaking everyone.

So wait the answer to stopping smoking is to create a punitive pay system where only people who are well off can afford to smoke?

And how does this actually stop people from smoking? Because if trying to stop drug use by making it punitive to use them didn't have the intended effect of curtailing usage and making narcotic more expensive/harder to obtain I don't see how this will. All this will do is create an avenue to create a black market for cigs.

This idea is the most ridiculous thing I have ever heard. It didn't work with narcotics (albeit it is a different tactic, but the same intended outcome, make drugs harder to get) it won't work with nicotine. It's a chemically addictive substance; people will do anything to get their fix.

This is a pretty bad idea. Smoking is already so heavily taxed that there's a huge smuggling market. I've never been a smoker but even I know exactly where to buy cigarettes at half the price of retail.

I personally hate smoking. I won't date a smoker and won't party or associate with them. I had 4 uncles and 2 pairs of grandparents that died early because of smoking's complications.

The obvious impact of smoking is on medical or health insurance costs. Force smokers to buy enough health insurance to cover their medical costs. It's not fair for the rest of us to have to pay their medical bills. That's where enforcement needs to be applied. People should be offered cheaper insurance rates if they pass a nicotine test every 6 months or so. The insurance companies can easily identify the smokers or those that live with smokers. (Second hand smoke is nearly as bad.) OSHA can outlaw smoking in the office or factory if they haven't already. Most public places now outlaw smoking at least indoors. I don't frequent bars or casinos, the two main places where smoking seems to be still allowed so I should easily pass the "smoke test".

Of course that will never happen, because smoking (much like the lotteries) is hugely lucrative to the government and a great way to get the poor to tax themselves. I'd say lobbyists would prevent it too, but frankly the smoking industry lobbyists seem pretty impotent these days.

Calling the tobacco tax hugely lucrative for the government is disingenuous. The amount of revenue collected from the tobacco tax is less than 1% of total tax revenues. And what revenue is collected is largely a zero sum game as it mostly goes to offset the public health costs smokers create.

This all fits in with the devising more ways to denormalise smoking - smoke-free public areas, plain packaging, hidden from public view in shops etc. The point is that smoking is dangerous and addictive and, if introduced now, would be banned. It is an historical anomaly which we have to fix but it will take time.

If you want to quit smoking good for you. If you don't wanna quit smoking that's great too. The religious zeal with which so many attack the smoking issue is insane to me. There really isn't any credible data which shows a definite link between smoking and cancer. There's isn't even any that can show a define link between 2nd hand smoke and cancer. This is why the American Cancer Association will never say if you smoke you will get cancer. They always use the qualifier 'may' when speaking on this topic. Fact is there are plenty of people who have been life long smokers who NEVER developed cancer. Also, there are plenty of lifelong non-smokers who develop lung cancer and other cancers traditionally attributed to smoking.

Number 1) The American Cancer Association will gladly tell you that the risk of cancer is greatly exacerbated when coupled with smoking.

Number 2) As the child of a parent who has severe asthma, I can say with certainty that her asthma was tripped every time she was around second hand smoke!

Number 3) Smoking most certainly causes emphysema, a disease that's both crippling and expensive to treat.

Number 4) Smoking is very clearly linked to numerous other diseases.

I'm not saying we need to ban smoking. But to say, like you implied, that smoking is harmless, is pure bullshit. Smoking is also a tax on public health, and as such, smokers should pay more for healthcare insurance. Smoking is a known risk, a risk that people should be able to take upon themselves in a free society, but a risk none the less. Excessive taxation is not the answer, black markets will always appear when legit markets fail.

Yes really. You don't get something pretty damned obvious. Fact is there are LOTS of people who smoke and don't come down with anything. That pretty much makes it impossible for anyone with credibility to make the claim that smoking w/o a doubt causes cancer and will kill you. There is a genetic component to cancer and these other diseases you are trying to you are ignoring. I can't smoke because I'm asthmatic so no shit I can say w/o a doubt that smoking will kill me if I started. In the end this whole debate comes down to personal freedom. Let's be honest here. Tobacco isn't as dangerous as people like you claim/believe it is. cuz if it were it would be as illegal as weed is. Hell, I'm still amazed by the fact that alcohol is legal yet weed isn't because there is concrete proof that alcohol kills MANY people each year and many of those are innocents. Anyway, go show me where a medical professional tells us that smoking will w/o any doubt lead to those sicknesses and that smoking is the ONLY way those sicknesses are contracted. No one will tell you that because it's untrue.

OMG what a bad idea. Prohibition has a terrible history, and yet the prohibiters always think that they can do it better this time.

If smoking incurs a cost on society because we're not cold-hearted enough to just let smokers keel over, then fully burden the cost of smokers' extra health care into cigarettes. I'd guess that the tax would actually be less than the "sin" taxes that are currently charged and then end up going into whatever purpose the special interests have lobbied for the hardest.

If you want to quit smoking good for you. If you don't wanna quit smoking that's great too. The religious zeal with which so many attack the smoking issue is insane to me. There really isn't any credible data which shows a definite link between smoking and cancer. There's isn't even any that can show a define link between 2nd hand smoke and cancer. This is why the American Cancer Association will never say if you smoke you will get cancer. They always use the qualifier 'may' when speaking on this topic. I don't get why weed is illegal yet Alcohol and tobacco aren't. Fact is there are plenty of people who have been life long smokers who NEVER developed cancer. Also, there are plenty of lifelong non-smokers who develop lung cancer and other cancers traditionally attributed to smoking.

Fact is there are LOTS of people who smoke and don't come down with anything.

Fact is there are LOTS of people who get shot in the head and don't die. Fact is there are LOTS of people who have unprotected sex and don't come down with anything. etc.

The point is that smoking, combined with some genetic combinations, leads to cancer. I'm all for personal freedom, but I think it's pretty obvious that smoking is more dangerous than not smoking. Until we get better at figuring EXACTLY what causes smokers' cancers, the best we can do is point at the smoke.

And what revenue is collected is largely a zero sum game as it mostly goes to offset the public health costs smokers create.

The fungibility of money makes this irrelevant. The funds paying for the health costs come out of a different bucket than the funds coming out of cigarette taxes. I agree that it SHOULD be zero sum and that cigarette taxes should pay for smokers' above and beyond health care, but that's just not the situation today.

Tell that to people who need full time care due to emphysema or other lovely diseases. A lower lifetime does not mean lower health care costs. There's a reason insurers have bean counters!

From the article I linked:

Quote:

The actual numbers for lifetime from 20 years old medical costs were:

The lifetime costs were in Euros:

Healthy: 281,000

Obese: 250,000

Smokers: 220,000

It's not just that one study. Many others have shown it as well. Smoking will kill you, and kill you young, and as a result you avoid the types of end-of-life, expensive diseases that actually run up health case costs, like Alzheimer's.

And I work for an insurance company, and write the software the bean-counters use. Smoking figures into actuarial tables heavily for life insurance, because you die younger. The only reason it impacts health insurance premiums in the US is because the expensive end-of-life stuff that healthy people end up needing treatment for doesn't happen to private insurers - by the time Alzheimer's and replacing-hips-from-osteoporosis and the like kick in, you're on Medicare. So healthy people shove their higher-than-smoker healthcare costs out of the private market and onto the public.

Yes really. You don't get something pretty damned obvious. Fact is there are LOTS of people who smoke and don't come down with anything. That pretty much makes it impossible for anyone with credibility to make the claim that smoking w/o a doubt causes cancer and will kill you. There is a genetic component to cancer and these other diseases you are trying to you are ignoring. I can't smoke because I'm asthmatic so no shit I can say w/o a doubt that smoking will kill me if I started. In the end this whole debate comes down to personal freedom. Let's be honest here. Tobacco isn't as dangerous as people like you claim/believe it is. cuz if it were it would be as illegal as weed is. Hell, I'm still amazed by the fact that alcohol is legal yet weed isn't because there is concrete proof that alcohol kills MANY people each year and many of those are innocents. Anyway, go show me where a medical professional tells us that smoking will w/o any doubt lead to those sicknesses and that smoking is the ONLY way those sicknesses are contracted. No one will tell you that because it's untrue.

I don't believe anyone ever claimed it was a 100% rate, but the fact is there a large amount of evidence to show that smoking greatly increases your risk of cancer.I have never heard anyone claim that "smoking w/o a doubt causes cancer and will kill you." No one. Ever.The idea presented in the article is awful, but your claims are equally ill-informed.